CT scan shows 4mm hypodense lesion

[zufa12k]

I am in week 8 of a clinical trial using two DAA plus SOC, UND at week 2, really good news, now for the bad.

My doctor had ordered a CT scan, this is seperate from my clinical trial, I got back the following:
"4mm hypodense lesion on the portal venous phase in segment 8, which does not demonstrate hypervascularity. This could represent a dysplastic nodule but a tiny hypovascular HCC cannot be excluded. "
My doctor isn't sure what the next steps should be and is getting me into to see a specialist.

I am all over the place on this, does anyone have any experience with a ‘hypodense lesion’?

[eureka254]

Hypodense lesion simply indicates the presence of presence of a mass not consistent with liver tissue.  It is certainly important to follow up and do additional testing to rule out malignancy, but most lesions of the liver are benign, and I hope that is the case with your finding.

The risk of malignant liver tumor is low in the general population, and remains so even in those with chronic hcv as long as there is no significant liver damage.  If you do not have cirrhosis due to hep c (or another condition like hemochromatosis or co-infection with hep b), their is low likelihood of HCC; regardless, it's good that your doctor is referring you to a specialist if s/he does not have expertise in this field.  Hope that helps, and best of luck on your next round of tests! ~eureka

[22hamilton]

Goog luck with that my friend. Fingers crossed for you but think you will be ok.
Great answer Hector. Are they able to do anything with your tumour or are they just monitoring it ? What are your transplant chances ?

Stay well all

Paul

[HectorSF]

Before I forget...You must see a hepatologist at a liver transplant clinic to have the best expertise available. No one else is qualified to treat you. Diagnosing HCC takes a lot of expertise. You need a "tumor board" which they have at transplant centers made up of oncologists, radiologists, hepatologists and others to properly diagnose liver lesions. This is of utmost of importance. You don't want anyone else missing a diagnosis of HCC! Err on the side of caution. IF and that is a big if, the lesion turns out to be HCC you want to catch it as early as possible. It will give you the most options for treatment. I have ESLD and a 1.7 cm HCC tumor so trust my experience on this. ( I am also 59 years old by the way).

This is a lesion in segment 8 (Superior subsegment of the anterior segment) on the right side of your liver. It is very small. "does not demonstrate hypervascularity" means it doesn't show conclusive evidence of being HCC. This is good news indeed. It is not uncommon for a dysplastic nodule to develop in a liver with cirrhosis. You do have cirrhosis I assume.
"The classification and description of dysplastic nodules and early HCC has been recently revised to harmonize the approaches taken by Western and Japanese pathologists.
These studies have been undertaken on resected tissue, whereas samples from lesions detected on surveillance usually only have a needle biopsy to evaluate. It is important to recognize that rather than being individual discrete states, there is a continuum
between HGDN and HCC. This complicates the evaluation of biopsies from small nodules."

What needs to be done in any case of a lesion in the liver is that it needs to be monitored closely.
"Patients with liver nodules having a nonspecific vascular profile and negative biopsy should continue to undergo enhanced follow-up. There are no data to establish the best follow-up policy at this point, but repeated biopsy or follow-up CT/MRI to detect further growth should be considered."

A biopsy should be done by an expert  by expert pathologists who is familiar with diagnosing liver cancer. (See 8 below)

How is your AFP level now?

Here is the AASLD PRACTICE GUIDELINE for detecting and monitoring liver lesions.
http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20practice%20Guidelines/Hccupdate2010.pdf

Recommendations:
6. Nodules found on ultrasound surveillance that are smaller than 1 cm should be followed with ultrasound at intervals from 3-6 months (level III). If there has been no growth over a period of up to 2 years, one can revert to routine surveillance (level III).
7. Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either 4-phase multidetector CT scan or dynamic contrast  nhanced MRI. If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be performed, or the lesion should be biopsied (level II).
8. Biopsies of small lesions should be evaluated by expert pathologists. Tissue that is not clearly HCC should be stained with all the available markers including CD34, CK7, glypican 3, HSP-70, and glutamine synthetase to improve diagnostic accuracy (level III).
9. If the biopsy is negative for patients with HCC, the lesion should be followed by imaging at 3-6 monthly intervals until the nodule either disappears, enlarges, or displays diagnostic characteristics of HCC. If the lesion enlarges but remains atypical for HCC a repeat biopsy is recommended (level III).

Hopefully you don't have HCC and it will turn out to be a false alarm. But this is a good reminder for all of us with cirrhosis to be continually monitored with imaging every 6 months to look for HCC as the probability of developing HCC increases every year we are cirrhotic.

I am sure you are very upset and may be in shock just even thinking that you could develop HCC. Try to hang in there. I know it isn't easy. Try to not get ahead of yourself. Deal with your current treatment now. Remember, as of right now it appears that you don't have HCC and it is only a lesion. Which is great news.
If you want you can send me a PM.

Hector